Benchmarking Survival Outcomes Following Surgical Management of pT3 and pT4 Cutaneous Squamous Cell Carcinoma of the Head and Neck

Amanda E Yung, Gareth Crouch, Alexander H R Varey, Serigne Lo, Michael S Elliott, Jenny Lee, Robert Rawson, Ruta Gupta, Angela M Hong, Jonathan R Clark, Sydney Ch'ng, Amanda E Yung, Gareth Crouch, Alexander H R Varey, Serigne Lo, Michael S Elliott, Jenny Lee, Robert Rawson, Ruta Gupta, Angela M Hong, Jonathan R Clark, Sydney Ch'ng

Abstract

Background: pT3/4 head and neck cutaneous squamous cell carcinomas (HNcSCCs) are associated with poor outcomes, including local recurrence, metastasis and death. Whilst surgery remains the standard treatment for advanced HNcSCC, novel systemic therapies, such as immunotherapy, are being used earlier in the treatment paradigm. It is imperative that the clinical outcomes of surgery are clearly described so that conventional and emerging treatment modalities can be better integrated and sequenced in the management of pT3/4 HNcSCC.

Methods: Patients with confirmed pT3/4 HNcSCC undergoing curative surgical resection between 2014-2020 were identified retrospectively from a prospectively maintained research database. The primary outcomes of interest were locoregional control (LRC), disease-specific survival (DSS), and overall survival (OS). The secondary outcome was surgical complication rate.

Results: A total of 104 patients (median age 74, range 41-94 years) were included, 90% of which had pT3 tumors; 36.5% received adjuvant radiotherapy. Median follow-up was 24.3 (range 1.0-84.3) months. LRC at 5 years was 62.0%, DSS at 5 years was 83.7%, and OS at 5 years was 71.9%. Median time to recurrence was 8.4 months. LRC was reduced in the presence of margin involvement and previous treatment (radiotherapy/surgery). The major surgical complication rate was 9.6%.

Conclusions: More than 60% of patients treated surgically for pT3/4 head and neck cSCC were alive and free of disease at 5 years posttreatment. High-risk features such as margin involvement and having had previous treatment (radiotherapy/surgery) should be used to guide adjuvant therapy.

Conflict of interest statement

No conflicts of interest have been declared.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves demonstrating locoregional control, disease specific survival and overall survival in a cohort of 104 patients with advanced cSCC of the head and neck

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